﻿<%@ Page Title="" Language="C#" MasterPageFile="~/common/AfterLogin.master" AutoEventWireup="true" CodeFile="insurance_apply_accident.aspx.cs" Inherits="product_insurance_user_insurance_apply_accident" %>


<asp:Content ID="Content3" ContentPlaceHolderID="leftMenu" Runat="Server">
    <ul>
        
                    <li>
                   <a href="<%= Page.ResolveUrl("~/product/insurance/user/insurance_statement.aspx")%>">Plan Statement</a></li>
                   <li><a href="<%= Page.ResolveUrl("~/product/insurance/user/insurance_certificate.aspx")%>">Plan Certificate</a></li>
                   <li><a href="<%= Page.ResolveUrl("~/product/insurance/user/insurance_terminate.aspx")%>">Terminate A Plan</a></li>
                   <li><a href="<%= Page.ResolveUrl("~/product/insurance/user/insurance_claim.aspx")%>">Claim Instructions</a></li>
                   <li><a href="<%= Page.ResolveUrl("~/product/insurance/insurance_accident.aspx")%>">Look For Plan Details</a></li>
                   <li><a href="<%= Page.ResolveUrl("~/product/insurance/user/insurance_apply_hospital.aspx")%>">Apply For Hospitalisation Plan</a></li>          
    </ul>

</asp:Content>
<asp:Content ID="Content4" ContentPlaceHolderID="content" Runat="Server">
<style>
fieldset
{
    border:0;
}
h5
{
    font-size:1.6em;border: 1px solid #FA5882;background-color : #FA5882;color: White;width: 750px; 
                text-align: center; margin-left:-11px; font-family: Andalus;
}
</style>

 <h1 style="font-size: 2.0em; text-transform: none; font-weight: 900; font-family: Andalus;">
        Power Saver Personal Accident Online Application</h1>
    <p>
        &nbsp;</p>
    <p>
        Power Saver Personal Accident is more than a conventional Personal Accident insurance
        policy. Protect your loved ones should you meet with any mishaps. Enjoy peace of
        mind with our comprehensive range of life essential benefits. Your children and
        parents are also well taken care of with our Children's Education Fund and Parent's
        Shield benefits. View plan details. Please refer to the terms and conditions before
        filling out this application.</p>
    <p>
        To be eligible:</p>
    <p>
        (a) Cover under this Policy shall be subject to the fulfillment of all of the following
        eligibility requirements by the Insured Persons:<br />
        <br />
        (i) satisfy the entry age - You and your Spouse are from 18 to 65 years (Age Next
        Birthday); and<br />
        - Your Child is from 15 days to 18 years (Age Next Birthday); and<br />
        (ii) are Residents of Singapore; and<br />
        (iii) are insurable in accordance with our terms and standards of acceptance; and<br />
        (iv) you pay the applicable premiums.<br />
        <br />
        (b) Subject to our approval, cover for you and your Spouse may be renewed up to
        75 years (Age Next Birthday). Cover for your Children may be renewed up to 25 years
        (Age Next Birthday) provided that they are unmarried, unemployed and full-time students
        in a recognised institution of higher learning.
    </p>
    <p>
        &nbsp;</p>
        <h5>Particulars of Person to be Insured </h5>
 <fieldset>
        <legend></legend>

        <table id="tbl_personalDetail" >
            <tr>
                <td >
                    First name:&nbsp;&nbsp;&nbsp;
                    </td>
                <td >
                    <asp:TextBox ID="tbi_firstName" runat="server" Enabled="False"></asp:TextBox>
                </td>
                <td >
                    Last name:&nbsp;&nbsp;&nbsp;
                    </td>
                <td>
                    <asp:TextBox ID="tbi_lastName" runat="server" Enabled="False"></asp:TextBox>
                </td>
            </tr>
            <tr>
                <td >
                    NRIC:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    </td>
                <td >
                    <asp:TextBox ID="tbi_nric" runat="server" Enabled="False"></asp:TextBox>
                </td>
                <td >
                    Nationality:&nbsp;&nbsp;
                    </td>
                <td>
                    <asp:TextBox ID="tbi_nationality" runat="server" Enabled="False"></asp:TextBox>
                </td>
            </tr>
            <tr>
                <td >
                    Gender:
                    &nbsp;
                    </td>
                <td >
                    <asp:RadioButton ID="rbi_male" runat="server" Text="Male" GroupName="gender" 
                        Enabled="False" Checked="True"/>
&nbsp;
                    <asp:RadioButton ID="rbi_female" runat="server" Text="Female" GroupName="gender" 
                        Enabled="False"/>
                </td>
                <td >
                    Marital status:</td>
                <td>
                    <asp:DropDownList ID="ddli_maritalStatus" runat="server" >
                        <asp:ListItem>Single</asp:ListItem>
                        <asp:ListItem>Married</asp:ListItem>
                        <asp:ListItem>Widowed</asp:ListItem>
                        <asp:ListItem>Divorced</asp:ListItem>
                    </asp:DropDownList>
                </td>
            </tr>
            <tr>
                <td >
                    Date of Birth:&nbsp;&nbsp;
                    </td>
                <td >
                    <asp:TextBox ID="tbi_dob" runat="server" Enabled="False"></asp:TextBox>
                </td>
                <td >
                    Occupation:&nbsp;&nbsp;&nbsp;
                    </td>
                <td>
                    <asp:TextBox ID="tbi_occupation" runat="server"></asp:TextBox>
                    <asp:RequiredFieldValidator ID="vd_occupation" runat="server" ControlToValidate="tbi_occupation" ErrorMessage="Pleaes input Occupation" ForeColor="Red"></asp:RequiredFieldValidator>
                </td>
            </tr>
            <tr>
                <td >
                    Have you been in Singapore for more than 182 days at the time of application?</td>
                <td >
                    <asp:RadioButton ID="rbi_yes" runat="server" Checked="True" 
                        GroupName="longStay" Text="Yes" />
&nbsp;
                    <asp:RadioButton ID="rbi_no" runat="server" GroupName="longStay" Text="No" />
                </td>
                <td >
                    &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    </td>
                <td>
                    &nbsp;
                </td>
            </tr>
            <tr>
                <td>
                    Tel(H):&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    </td>
                <td>
                    <asp:TextBox ID="tbi_tel" runat="server"></asp:TextBox>
                    <asp:RequiredFieldValidator ID="vd_tel" runat="server" ControlToValidate="tbi_tel" ErrorMessage="Please input tel number" ForeColor="Red"></asp:RequiredFieldValidator>
                </td>
                <td>
                    Mobile:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    </td>
                <td>
                    <asp:TextBox ID="tbi_mobile" runat="server"></asp:TextBox>
                    <asp:RequiredFieldValidator ID="vd_mobile" runat="server" ControlToValidate="tbi_mobile" ErrorMessage="Please input Mobile" ForeColor="Red"></asp:RequiredFieldValidator>
                </td>
            </tr>
            <tr>
                <td>
                    Email:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    </td>
                <td>
                    <asp:TextBox ID="tbi_email" runat="server" Width="257px"></asp:TextBox>
                </td>
                <td>
                    &nbsp;</td>
                <td>
                    &nbsp;</td>
            </tr>
            <tr>
                <td>
                    Mailing Address: 
                </td>
                <td>
                    <asp:TextBox ID="tbi_mailingAddress" runat="server" Width="261px"></asp:TextBox>
                    <asp:RequiredFieldValidator ID="vd_email" runat="server" ControlToValidate="tbi_mailingAddress" ErrorMessage="Please input Email" ForeColor="Red"></asp:RequiredFieldValidator>
                </td>
                <td>
                    Postal code:&nbsp;&nbsp;
                    </td>
                <td>
                    <asp:TextBox ID="tbi_postal" runat="server"></asp:TextBox>
                    <asp:RequiredFieldValidator ID="vd_postal" runat="server" ControlToValidate="tbi_postal" ErrorMessage="Please input postal code" ForeColor="Red"></asp:RequiredFieldValidator>
                </td>
            </tr>
           
            <tr>
                <td>
                    &nbsp;</td>
                <td>
                    &nbsp;</td>
                <td>
                    &nbsp;</td>
                <td>
                    &nbsp;</td>
            </tr>
        </table>
</fieldset>
<h5>Particulars of Family Members to be Insured</h5>
<fieldset>
        <legend><asp:CustomValidator ID="vd_family" runat="server" ErrorMessage="Please complete family infomation" ForeColor="Red" OnServerValidate="vd_family_ServerValidate"></asp:CustomValidator>
        </legend>



        <table class="style1">
            <tr>
                <td>
                    &nbsp;</td>
                <td>
                    &nbsp;First Name&nbsp;</td>
                <td>
                    Last name</td>
                <td>
                    NRIC/FIN/BC No.</td>
                <td>
                    Date of birth<br />
                    (dd/mm/yyyy</td>
                <td>
                    &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    Gender</td>
            </tr>
            <tr>
                <td>
                    Spouse :</td>
                <td>
                    <asp:TextBox ID="tbs_fname" runat="server" Width="114px"></asp:TextBox>
                </td>
                <td>
                    <asp:TextBox ID="tbs_lname" runat="server" Width="113px"></asp:TextBox>
                </td>
                <td>
                    <asp:TextBox ID="tbs_nric" runat="server" Width="104px"></asp:TextBox>
                </td>
                <td>
                    <asp:TextBox ID="tbs_dob" runat="server" Width="93px"></asp:TextBox>
                </td>
                <td>
                    <asp:RadioButton ID="rbs_male" runat="server" Text="Male" Checked="True" 
                        GroupName="rb_gender" />
&nbsp;
                    <asp:RadioButton ID="rbs_female" runat="server" Text="Female" 
                        GroupName="rb_gender" />
                </td>
            </tr>
            <tr>
                <td>
                    Child 1:</td>
                <td>
                    <asp:TextBox ID="tbc1_fname" runat="server" Width="116px"></asp:TextBox>
                </td>
                <td>
                    <asp:TextBox ID="tbc1_lname" runat="server" Width="114px"></asp:TextBox>
                </td>
                <td>
                    <asp:TextBox ID="tbc1_nric" runat="server" style="margin-left: 0px" 
                        Width="104px"></asp:TextBox>
                </td>
                <td>
                    <asp:TextBox ID="tbc1_dob" runat="server" Width="94px"></asp:TextBox>
                </td>
                <td>
                    <asp:RadioButton ID="rbc1_male" runat="server" Text="Male" Checked="True" 
                        GroupName="rb_gender2" />
&nbsp;
                    <asp:RadioButton ID="rbc1_female" runat="server" Text="Female" 
                        GroupName="rb_gender2" />
                </td>
            </tr>
            <tr>
                <td>
                    Child 2:</td>
                <td>
                    <asp:TextBox ID="tbc2_fname" runat="server" Width="116px"></asp:TextBox>
                </td>
                <td>
                    <asp:TextBox ID="tbc2_lname" runat="server" Width="112px"></asp:TextBox>
                </td>
                <td>
                    <asp:TextBox ID="tbc2_nric" runat="server" Width="104px"></asp:TextBox>
                </td>
                <td>
                    <asp:TextBox ID="tbc2_dob" runat="server" Width="94px"></asp:TextBox>
                </td>
                <td>
                    <asp:RadioButton ID="rbc2_male" runat="server" Text="Male" Checked="True" 
                        GroupName="rb_gender3" />
&nbsp;
                    <asp:RadioButton ID="rbc2_female" runat="server" Text="Female" 
                        GroupName="rb_gender3" />
                </td>
            </tr>
            <tr>
                <td>
                    Child 3:</td>
                <td>
                    <asp:TextBox ID="tbc3_fname" runat="server" Width="114px"></asp:TextBox>
                </td>
                <td>
                    <asp:TextBox ID="tbc3_lname" runat="server" Width="113px"></asp:TextBox>
                </td>
                <td>
                    <asp:TextBox ID="tbc3_nric" runat="server" Width="104px"></asp:TextBox>
                </td>
                <td>
                    <asp:TextBox ID="tbc3_dob" runat="server" Width="95px"></asp:TextBox>
                </td>
                <td>
                    <asp:RadioButton ID="rbc3_male" runat="server" Text="Male" Checked="True" 
                        GroupName="rb_gender4" />
&nbsp;
                    <asp:RadioButton ID="rbc3_female" runat="server" Text="Female" 
                        GroupName="rb_gender4" />
                </td>
            </tr>
            <tr>
                <td>
                    Occupation<br />
                    of Spouse:</td>
                <td>
                    <asp:TextBox ID="tbs_occupation" runat="server" Width="113px"></asp:TextBox>
                </td>
                <td>
                    &nbsp;</td>
                <td>
                    &nbsp;</td>
                <td>
                    &nbsp;</td>
                <td>
                    &nbsp;</td>
            </tr>
        </table>



    </fieldset>

    <h5>Details of Employer</h5>
<fieldset>
        <legend></legend>

        <table id= "tbl_employerDetail" >
            <tr>
                <td>
                    Name of Employer:</td>
                <td>
                    <asp:TextBox ID="tbe_name" runat="server" style="margin-left: 2px"></asp:TextBox>
                    <asp:RequiredFieldValidator ID="vd_employer" runat="server" ControlToValidate="tbe_name" ErrorMessage="Pleaes input Name of Employer" ForeColor="Red"></asp:RequiredFieldValidator>
                </td>
            </tr>

            <tr>
                <td>
                    Address of Employer:</td>
                <td>
                    <asp:TextBox ID="tbe_address" runat="server"></asp:TextBox>
                    <asp:RequiredFieldValidator ID="vd_address" runat="server" ControlToValidate="tbe_address" ErrorMessage="Please input Address of Employer" ForeColor="Red"></asp:RequiredFieldValidator>
                </td>
            </tr>
            <tr>
                <td>
                    Nature of Employer’s Business:</td>
                <td>
                    <asp:TextBox ID="tbe_business" runat="server"></asp:TextBox>
                    <asp:RequiredFieldValidator ID="vd_business" runat="server" ControlToValidate="tbe_business" ErrorMessage="Pleae input Business" ForeColor="Red"></asp:RequiredFieldValidator>
                </td>
            </tr>
        </table>

</fieldset>
<h5>Questionnaire</h5>
 <fieldset>
        <legend></legend>
 
        <table>
            <tr>
                <td>
                    <asp:Label ID="lbq1_disease" runat="server" Text="1. Is any of the applicants have or ever had any disease, infirmity, illness or physical defect?"></asp:Label>
                    &nbsp;
                    <br />
&nbsp; If yes, please give FULL name and details:<br />
                    <asp:CustomValidator ID="vd_disease" runat="server" ErrorMessage="Please input full information" ForeColor="Red" OnServerValidate="vd_disease_ServerValidate"></asp:CustomValidator>
                    <br />
&nbsp;
                    <table>
                        <tr>
                            <td >
                                Full Name</td>
                            <td>
                                Details</td>
                        </tr>
                        <tr>
                            <td>
                                <asp:TextBox ID="tbq1_name1" runat="server"></asp:TextBox>
                            </td>
                            <td>
                    <asp:TextBox ID="tbq1_disease1" runat="server" 
                                    Width="273px"></asp:TextBox>
                            </td>
                        </tr>
                        <tr>
                            <td>
                                <asp:TextBox ID="tbq1_name2" runat="server"></asp:TextBox>
                            </td>
                            <td>
                    <asp:TextBox ID="tbq1_disease2" runat="server" 
                                    Width="273px"></asp:TextBox>
                            </td>
                        </tr>
                        <tr>
                            <td>
                                <asp:TextBox ID="tbq1_name3" runat="server"></asp:TextBox>
                            </td>
                            <td>
                    <asp:TextBox ID="tbq1_disease3" runat="server"  
                                    Width="272px"></asp:TextBox>
                            </td>
                        </tr>
                        <tr>
                            <td>
                                <asp:TextBox ID="tbq1_name4" runat="server"></asp:TextBox>
                            </td>
                            <td>
                    <asp:TextBox ID="tbq1_disease4" runat="server" 
                                    Width="272px"></asp:TextBox>
                            </td>
                        </tr>
                    </table>
                    <br />
                </td>
            </tr>
            <tr>
                <td>
                    <asp:Label ID="lbq2_hazardous" runat="server" Text="2. Is any of the applicants engaged in anything hazardous in your/their occupation, sports or any other 
                    pursuits? "></asp:Label>
                    <br />
&nbsp; If yes, please give FULL name and details:<br />
                    <br />
&nbsp;<asp:CustomValidator ID="vd_hazardous" runat="server" ErrorMessage="Please input full information" ForeColor="Red" OnServerValidate="vd_hazardous_ServerValidate"></asp:CustomValidator>
&nbsp;<table class="style10">
                        <tr>
                            <td>
                                Full Name</td>
                            <td>
                                Details</td>
                        </tr>
                        <tr>
                            <td>
                                <asp:TextBox ID="tbq2_name1" runat="server"></asp:TextBox>
                            </td>
                            <td>
                    <asp:TextBox ID="tbq2_hazardous1" runat="server" Width="265px"></asp:TextBox>
                            </td>
                        </tr>
                        <tr>
                            <td>
                                <asp:TextBox ID="tbq2_name2" runat="server"></asp:TextBox>
                            </td>
                            <td>
                    <asp:TextBox ID="tbq2_hazardous2" runat="server" Width="265px"></asp:TextBox>
                            </td>
                        </tr>
                        <tr>
                            <td>
                                <asp:TextBox ID="tbq2_name3" runat="server"></asp:TextBox>
                            </td>
                            <td>
                    <asp:TextBox ID="tbq2_hazardous3" runat="server" Width="265px"></asp:TextBox>
                            </td>
                        </tr>
                        <tr>
                            <td>
                                <asp:TextBox ID="tbq2_name4" runat="server"></asp:TextBox>
                            </td>
                            <td>
                    <asp:TextBox ID="tbq2_hazardous4" runat="server" Width="266px"></asp:TextBox>
                            </td>
                        </tr>
                    </table>
                    <br />
                </td>
            </tr>
            <tr>
                <td>
                    <asp:Label ID="lbq3_travelFrequency" runat="server" Text="3.  Is any of the applicants travel frequently? What is the frequency of these trips per year?"></asp:Label>
                    <br />
&nbsp;&nbsp; If yes, please give FULL name and details:<br />
                    <asp:CustomValidator ID="vd_travelFrequency" runat="server" ErrorMessage="Please input full information" ForeColor="Red" OnServerValidate="vd_travelFrequency_ServerValidate"></asp:CustomValidator>
                    <br />
&nbsp;
                    <table>
                        <tr>
                            <td>
                                Full Name</td>
                            <td>
                                Details</td>
                        </tr>
                        <tr>
                            <td>
                                <asp:TextBox ID="tbq3_name1" runat="server" Height="22px"></asp:TextBox>
                            </td>
                            <td>
                    <asp:TextBox ID="tbq3_travelFrequency1" runat="server" Height="22px" Width="260px"></asp:TextBox>
                            </td>
                        </tr>
                        <tr>
                            <td>
                                <asp:TextBox ID="tbq3_name2" runat="server" Height="22px"></asp:TextBox>
                            </td>
                            <td>
                    <asp:TextBox ID="tbq3_travelFrequency2" runat="server" Width="259px"></asp:TextBox>
                            </td>
                        </tr>
                        <tr>
                            <td>
                                <asp:TextBox ID="tbq3_name3" runat="server" Height="22px"></asp:TextBox>
                            </td>
                            <td>
                    <asp:TextBox ID="tbq3_travelFrequency3" runat="server" Width="258px"></asp:TextBox>
                            </td>
                        </tr>
                        <tr>
                            <td>
                                <asp:TextBox ID="tbq3_name4" runat="server" Height="22px"></asp:TextBox>
                            </td>
                            <td>
                    <asp:TextBox ID="tbq3_travelFrequency4" runat="server" Width="257px"></asp:TextBox>
                            </td>
                        </tr>
                    </table>
                    <br />
                </td>
            </tr>
            <tr>
                <td>
                    <asp:Label ID="lbq4_declinedHistory" runat="server" Text="4. Has any insurer in connection with Life, Personal Accident or Sickness Insurance ever 
                    deferred or declined your Proposal,refused or terminated an insurance or imposed 
                    special terms?"></asp:Label>
                    <br />
&nbsp;&nbsp; If yes, please give FULL name and details:<br />
                    <br />
                    <asp:CustomValidator ID="vd_declinedHistory" runat="server" 
                        ErrorMessage="Please input full information" ForeColor="Red" 
                        onservervalidate="vd_declinedHistory_ServerValidate"></asp:CustomValidator>
&nbsp;<table class="style10">
                        <tr>
                            <td>
                                Full Name</td>
                            <td>
                                Details</td>
                        </tr>
                        <tr>
                            <td>
                                <asp:TextBox ID="tbq4_name1" runat="server"></asp:TextBox>
                            </td>
                            <td>
                    <asp:TextBox ID="tbq4_declinedHistory1" runat="server" style="margin-left: 0px" 
                                    Width="254px"></asp:TextBox>
                            </td>
                        </tr>
                        <tr>
                            <td>
                                <asp:TextBox ID="tbq4_name2" runat="server"></asp:TextBox>
                            </td>
                            <td>
                    <asp:TextBox ID="tbq4_declinedHistory2" runat="server" style="margin-left: 0px" 
                                    Width="253px"></asp:TextBox>
                            </td>
                        </tr>
                        <tr>
                            <td>
                                <asp:TextBox ID="tbq4_name3" runat="server"></asp:TextBox>
                            </td>
                            <td>
                    <asp:TextBox ID="tbq4_declinedHistory3" runat="server" Width="253px"></asp:TextBox>
                            </td>
                        </tr>
                        <tr>
                            <td>
                                <asp:TextBox ID="tbq4_name4" runat="server"></asp:TextBox>
                            </td>
                            <td>
                    <asp:TextBox ID="tbq4_declinedHistory4" runat="server" Width="252px"></asp:TextBox>
                            </td>
                        </tr>
                    </table>
                    <br />
                </td>
            </tr>
            <tr>
                <td>
                    &nbsp;</td>
            </tr>
        </table>
 
</fieldset> 
<h5>Details of Insurance</h5>
<fieldset>
         <legend></legend>
        <table>
            <tr>
                <td >
                    Period of Insurance
                </td>
            </tr>
            <tr>
                <td >
                    Insurance to commence: From
                    <asp:TextBox ID="tbStartDate" runat="server"></asp:TextBox>
                    &nbsp;to
                    <asp:TextBox ID="tbEndDate" runat="server" ReadOnly="True"></asp:TextBox>
                    <asp:RequiredFieldValidator ID="vd_StartDate" runat="server" ControlToValidate="tbStartDate" ErrorMessage="Pleae input From date" ForeColor="Red"></asp:RequiredFieldValidator>
                </td>
            </tr>
            <tr>
                <td >
                    <table>
                        <tr>
                            <td>
                                Choice of plan</td>
                            <td>
&nbsp;&nbsp; Gold</td>
                            <td>
&nbsp;&nbsp; Silver</td>
                            <td>
&nbsp;&nbsp; Bronze</td>
                        </tr>
                        <tr>
                            <td>
                                Insured :</td>
                            <td>
                                <asp:RadioButton ID="rbi_gold" runat="server" Text="468" GroupName="rbi_plan" />
                            </td>
                            <td>
                                <asp:RadioButton ID="rbi_silver" runat="server" Text="328" 
                                    GroupName="rbi_plan" Checked="True" />
                            </td>
                            <td>
                                <asp:RadioButton ID="rbi_bronze" runat="server" Text="186" 
                                    GroupName="rbi_plan" />
                            </td>
                        </tr>
                        <tr>
                            <td>
                                Spouse :</td>
                            <td>
                                <asp:RadioButton ID="rbs_gold" runat="server" Text="418" GroupName="rbs_plan" />
                            </td>
                            <td>
                                <asp:RadioButton ID="rbs_silver" runat="server" Text="288" 
                                    GroupName="rbs_plan" Checked="True" />
                            </td>
                            <td>
                                <asp:RadioButton ID="rbs_bronze" runat="server" Text="168" 
                                    GroupName="rbs_plan" />
                            </td>
                        </tr>
                        <tr>
                            <td>
                                Each child :</td>
                            <td>
                                <asp:RadioButton ID="rbc_gold" runat="server" Text="188" GroupName="rbc_plan" />
                            </td>
                            <td>
                                <asp:RadioButton ID="rbc_silver" runat="server" Text="128" 
                                    GroupName="rbc_plan" Checked="True" />
                            </td>
                            <td>
                                <asp:RadioButton ID="rbc_bronze" runat="server" Text="68" 
                                    GroupName="rbc_plan" />
                            </td>
                        </tr>
                    </table>
&nbsp;<br />        Premium quoted above are inclusive of GST and may be subject to change without prior notice. The above premium is applicable for Class I and Class II risks. Please note:<br/>
                    Benefit per child is 50% of Main Insured's benefits.<br />
                    The above premium is not applicable for Class III, decline or referred risk.
                    <br />
                    <br />
                    <h2>
                        Classification of Risks:</h2>
                    <p>
                        Class I - Persons engaged in professional, administrative, managerial, clerical
                        and non-manual work solely in office or similar non-hazardous places<br />
                        <br />
                        Class II - Persons engaged in work of a supervisory nature and others not in class
                        I whose duties do not involve the use of tools or machinery or expose them to any
                        special hazard<br />
                        <br />
                        Class III - Persons engaged in manual work not of particularly hazardous nature
                        but involving the use of tools or machinery<br />
                        <br />
                        Referred risks - Persons working in Security Organisations, Construction Industries,
                        Entertainment Industries, Drivers and Carpenters and Class III risks</p>
                    <p>
                        Please note that this is an Accident Policy. The Benefit will only be payable upon
                        death or injury as a result of an accident occurring.</p>
                </td>
            </tr>
            <tr>
                <td >
                    &nbsp;
                </td>
            </tr>
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</fieldset>
<h5>Payment Method</h5>
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                    Please charge the annual premium
                  
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                        <asp:ListItem>Yearly</asp:ListItem>
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                    &nbsp;to my Power Save Account.
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            <tr>
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                    &nbsp;
                </td>
            </tr>
            <tr>
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                    &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    <asp:Button ID="btnReset" runat="server" Text="Reset Information" />
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        <br/>
       <P> Notes: 1) The premium stated is inclusive of GST and applicable for class I and Class II risks.<br/>
        &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
        2) Refer to underwriter for class III, decline or referred risks.</p>
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